Iezzi Roberto, Cotroneo Antonio Raffaele, Filippone Antonella, Giancristofaro Daniela, Storto Maria Luigia
Department of Clinical Science and Bioimaging, Section of Radiology, University G. D'Annunzio, SS. Annunziata Hospital, Via dei Vestini, Chieti, Italy.
J Comput Assist Tomogr. 2008 Sep-Oct;32(5):690-6. doi: 10.1097/RCT.0b013e3181576cfd.
To prospectively compare the diagnostic accuracy and quality of vascular enhancement of 2 contrast agents with different iodine concentrations in 4-detector row computed tomographic angiography of abdominal aorta and lower-extremity arteries.
Forty consecutive patients with peripheral arterial occlusive disease referred for conventional angiography (digital subtraction angiography [DSA]) of the lower extremity were prospectively enrolled in the study and underwent multidetector row computed tomographic angiography (CTA) receiving either 90 mL of iomeprol 400 (Iomeron 400, group A; Bracco Imaging S.p.A., Milan, Italy) or 120 mL of iomeprol 300 (Iomeron 300, group B; Bracco Imaging). Resultant images, both axial, maximum intensity projection, multiplanar reformatted, and volume-rendered 3-dimensional images, were independently evaluated by 2 clinically competent and experienced blinded radiologists for the presence of stenotic and occluded arterial segments using DSA as the standard of reference. Computed tomographic images were also evaluated quantitatively for maximum arterial and venous enhancement, and qualitatively for vascular opacification, venous overlap, and diagnostic efficacy. Quantitative and qualitative results of the 2 study agent groups were statistically compared. Both contrast media were evaluated for safety and tolerability.
From 760 segments, 722 arterial segments were effectively evaluated in the comparative analysis of CTA and DSA. In the evaluation of significant stenoses (>70%) and occluded segments, multidetector row CTA obtained a sensitivity, specificity, and accuracy of 97.1%, 96%, and 96.3%, and 98.9%, 100%, and 99%, respectively. Iomeprol 400 demonstrated an increased arterial enhancement in aortoiliac and femoral districts in comparison to iomeprol 300 (mean increase in opacification, 37.3 Hounsfield units) and a significant better qualitative assessment in the aortoiliac segments without an increase in venous opacification or the presence of venous overlap. No significant differences were found for sensitivity and specificity for the diagnosis of significant stenoses (>70%) and occluded segments. Both agents were well tolerated, and no adverse events were recorded.
The use of a small volume of a high-concentration contrast material yielded higher arterial enhancement from the abdominal aorta down to the femoral arteries with absent or minimal venous overlap and without significant differences in diagnostic ability.
前瞻性比较两种不同碘浓度的对比剂在腹主动脉和下肢动脉的四排螺旋CT血管造影中血管强化的诊断准确性和质量。
连续纳入40例因下肢常规血管造影（数字减影血管造影[DSA]）而转诊的外周动脉闭塞性疾病患者，前瞻性地进行研究，并接受多排螺旋CT血管造影（CTA），其中一组接受90 mL碘美普尔400（碘必乐400，A组；意大利米兰的博莱科影像公司），另一组接受120 mL碘美普尔300（碘必乐300，B组；博莱科影像）。由2名临床能力强且经验丰富的盲法放射科医生以DSA作为参考标准，对所得的轴位、最大密度投影、多平面重组和容积再现三维图像独立评估有无动脉狭窄和闭塞节段。还对CT图像进行定量评估，测量动脉和静脉的最大强化程度，并进行定性评估，观察血管显影、静脉重叠情况及诊断效能。对两组研究对比剂的定量和定性结果进行统计学比较。同时评估两种对比剂的安全性和耐受性。
在CTA与DSA的对比分析中，共有效评估了722个动脉节段（来自760个节段）。在评估重度狭窄（>70%）和闭塞节段时，多排螺旋CTA的敏感性、特异性和准确性分别为97.1%、96%和96.3%，以及98.9%、100%和99%。与碘美普尔300相比，碘美普尔400在腹主动脉和股动脉区域的动脉强化增加（平均强化增加37.3亨氏单位），在腹主动脉节段的定性评估明显更好，且静脉强化无增加或无静脉重叠。在诊断重度狭窄（>70%）和闭塞节段方面，两组的敏感性和特异性无显著差异。两种对比剂耐受性良好，未记录到不良事件。
使用小剂量高浓度对比剂可使从腹主动脉到股动脉的动脉强化更高，静脉重叠缺失或极少，且诊断能力无显著差异。
